JKAN Journal of Korean Academy of Nursing J Korean Acad Nurs 2005-3673 2093-758X Korean Society of Nursing Science 10.4040/jkan.2018.48.6.669 jkan-48-669 Original Article Psychoeducational Approach to Distress Management of Newly Diagnosed Patients with Breast Cancer ParkJin-Hee1 ChunMison2 JungYong Sik3 BaeSun Hyoung1 JungYoung-Mi4 College of Nursing · Research Institute of Nursing Science, Ajou University, Suwon Department of Radiation Oncology, School of Medicine, Ajou University, Suwon Department of Surgery, School of Medicine, Ajou University, Suwon Department of Nursing, College of Health Sciences, Cheongju University, Cheongju, Korea Address reprint requests to : Jung, Young-Mi Department of Nursing, College of Health Sciences, Cheongju University, 298 Daeseong-ro, Cheongwon-gu, Cheongju 28503, Korea Tel: +82-43-229-7848 Fax: +82-43-229-8969 E-mail: j-dudal@hanmail.net 012018 15012018 486 669678 270620180511201805112018 Copyright © 2018 Korean Society of Nursing Science 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium. Abstract Purpose

The purpose of this study was to examine the effects of integrated psychoeducational program for distress management of newly diagnosed patients with breast cancer.

 Methods

A quasi-experimental trial was conducted. The participants consisted of 47 female patients with breast cancer assigned to an intervention group (n=25) and control group (n=22). The intervention group participated in integrated psychoeducational program, consisting of individual face-to-face education and telephone-delivered health-coaching sessions. Data were collected at three time points: pre-intervention (T1), post-intervention (T2), and 6-month follow-up (T3). Study instruments were Distress thermometer, Supportive Care Needs Survey Short Form 34 and Functional Assessment of Cancer Therapy-Breast.

 Results

Compared with the control group, breast cancer patients in the intervention group reported lower distress and supportive care needs than the control group. The intervention group reported higher quality of life (QOL) overall and higher emotional well-being than the control group.

 Conclusion

These findings indicate that the integrated psychoeducational program is an effective intervention for reducing distress and supportive care needs and increasing QOL of newly diagnosed patients with breast cancer. Oncology nurses need to provide psychoeducational intervention to support patients with breast cancer in managing their distress and helping them adjust to their life.

 Breast Neoplasms Psychological Stress Self-Management Quality of Life Psychosocial Support Systems References Korean Breast Cancer SocietyBreast cancer facts & figures 2018 [Internet]SeoulKorean Breast Cancer Societyc2018[cited 2018 Nov 01]. Available from:http://www.kbcs.or.kr/journal/file/181030.pdf RunowiczCDLeachCRHenryNLHenryKSMackeyHTCowens-AlvaradoRLAmerican Cancer Society/Ameri-can Society of clinical oncology breast cancer survivorship care guidelineCA: A Cancer Journal for Clinicians20166614373https://doi.org/10.3322/caac.21319 SyrowatkaAMotulskyAKurtevaSHanleyJADixonWGMeguerditchianANPredictors of distress in female breast cancer survivors: A systematic reviewBreast Cancer Research and Treatment20171652229245https://doi.org/10.1007/s10549-017-4290-9 HollandJCAndersenBBreitbartWSBuchmannLOCom-pasBDeshieldsTLDistress managementJournal of the National Comprehensive Cancer Network2013112190209https://doi.org/10.6004/jnccn.2013.0027 LiaoMNChenSCChenSCLinYCChenMFWangCHChange and predictors of symptom distress in breast cancer patients following the first 4 months after diagnosisJournal of the Formosan Medical Association20151143246253https://doi.org/10.1016/j.jfma.2013.06.009 ParkJHChunMJungYSBaeSHPredictors of psychological distress trajectories in the first year after a breast cancer diagnosisAsian Nursing Research2017114268275https://doi.org/10.1016/j.anr.2017.10.003 LiaoMNChenSCChenSCLinYCHsuYHHungHCChanges and predictors of unmet supportive care needs in Taiwanese women with newly diagnosed breast cancerOncology Nursing Forum2012395E380E389https://doi.org/10.1188/12.onf.e380-e389 FiszerCDolbeaultSSultanSBrédartAPrevalence, intensity, and predictors of the supportive care needs of women diagnosed with breast cancer: A systematic reviewPsycho-Oncology2014234361374https://doi.org/10.1002/pon.3432 ParkJHChunMJungYSJungYMChanges of supportive care needs and quality of life in patients with breast cancerAsian Oncology Nursing2016164217225https://doi.org/10.5388/aon.2016.16.4.217 FagerlindHKettisÅGlimeliusBRingLBarriers against psychosocial communication: Oncologists’ perceptionsJournal of Clinical Oncology2013313038153822https://doi.org/10.1200/jco.2012.45.1609 BarsevickAMSweeneyCHaneyEChungEA systematic qualitative analysis of psychoeducational interventions for depression in patients with cancerOncology Nursing Forum20022917387https://doi.org/10.1188/02.onf.73-87 D’EgidioVSestiliCMancinoMSciarraICocchiaraRBackhausICounseling interventions delivered in women with breast cancer to improve health-related quality of life: A systematic reviewQuality of Life Research2017261025732592https://doi.org/10.1007/s11136-017-1613-6 MatsudaAYamaokaKTangoTMatsudaTNishimotoHEffectiveness of psychoeducational support on quality of life in early-stage breast cancer patients: A systematic review and meta-analysis of randomized controlled trialsQuality of Life Research20142312130https://doi.org/10.1007/s11136-013-0460-3 MilantiAMetsäläEHannulaLReducing psychological distress in patients undergoing chemotherapyBritish Journal of Nursing2016254S25S30https://doi.org/10.12968/bjon.2016.25.4.s25 Schulman-GreenDJeonSManaging cancer care: A psycho‐ educational intervention to improve knowledge of care options and breast cancer self‐managementPsycho-Oncology2017262173181https://doi.org/10.1002/pon.4013 WuPHChenSWHuangWTChangSCHsuMCEffects of a psychoeducational intervention in patients with breast cancer undergoing chemotherapyJournal of Nursing Research2018264266279https://doi.org/10.1097/jnr.0000000000000252 AshingKTMillerAMAssessing the utility of a telephonically delivered psychoeducational intervention to improve health-related quality of life in African American breast cancer survivors: A pilot trialPsycho-Oncology2016252236238https://doi.org/10.1002/pon.3823 DastanNBBuzluSPsychoeducation intervention to improve adjustment to cancer among Turkish stage I-II breast cancer patients: A randomized controlled trialAsian Pacific Journal of Cancer Prevention2012131053135318https://doi.org/10.7314/apjcp.2012.13.10.5313 van den BergSWGielissenMFMOttevangerPBPrinsJBRationale of the BREAst cancer e-healTH [BREATH] multicentre randomised controlled trial: An internet-based self-management intervention to foster adjustment after curative breast cancer by decreasing distress and increasing empowermentBMC Cancer201212394https://doi.org/10.1186/1471-2407-12-394 MensMGHelgesonVSLemberskyBCBaumAScheierMFRandomized psychosocial interventions for breast cancer: Impact on life purposePsycho-Oncology2016256618625https://doi.org/10.1002/pon.3891 LeeKSLeeRKimDMKimSHThe effects of a comprehensive education program on knowledge, self-efficacy, and coping style among newly diagnosed patients with breast cancerAsian Oncology Nursing20121213543https://doi.org/10.5388/aon.2012.12.1.35 OkONNamMSYiMSChoSMKimEJHamYHEffects of telephone counseling support on distress, anxiety, depression, and adverse events in cancer patients receiving chemotherapyAsian Oncology Nursing20171713744https://doi.org/10.5388/aon.2017.17.1.37 National Comprehensive Cancer NetworkDistress thermometer screening tool figure (DIS-A), V.2.2013 [Internet]Plymouth Meeting (PA)National Comprehensive Cancer Networkc2013[cited 2013 Jun 2]. Available from:https://www.nccn.org/global/international_adaptations.aspx BoyesAGirgisALecathelinaisCBrief assessment of adult cancer patients’ perceived needs: Development and validation of the 34‐item Supportive Care Needs Survey (SCNS-SF34)Journal of Evaluation in Clinical Practice2009154602606https://doi.org/10.1111/j.1365-2753.2008.01057.x BradyMJCellaDFMoFBonomiAETulskyDSLloydSRReliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrumentJournal of Clinical Oncology1997153974986https://doi.org/10.1200/jco.1997.15.3.974 YooHJAhnSHEremencoSKimHKimWKKimSBKorean translation and validation of the functional assessment of cancer therapy-breast (FACT-B) scale version 4Quality of Life Research200514616271632https://doi.org/10.1007/s11136-004-7712-1 CohenJStatistical power analysis for the behavioral sciences2nd edHillsdale (NJ)Lawrence Erlbaum Associates19881966 SchofieldPUgaldeAGoughKReeceJKrishnasamyMCareyMA tailored, supportive care intervention using systematic assessment designed for people with inoperable lung cancer: A randomised controlled trialPsycho-Oncology2013221124452453https://doi.org/10.1002/pon.3306 WhiteVMMacveanMLGroganSD’EsteCAkkermanDIeropoliSCan a tailored telephone intervention delivered by volunteers reduce the supportive care needs, anxiety and depression of people with colorectal cancer? A randomised controlled trialPsycho-Oncology2012211010531062https://doi.org/10.1002/pon.2019 AiZPGaoXLLiJFZhouJRWuYFChanging trends and influencing factors of the quality of life of chemotherapy patients with breast cancerChinese Nursing Research2017411823https://doi.org/10.1016/j.cnre.2017.03.006 Tables

Homogeneity Test of Demographic and Clinical Characteristics between Two Groups

Variables Categories Exp. (n=25) Cont. (n=22) χ2 p
n (%) n (%)
Age (yr) <40 5 (45.5) 6 (54.5) 1.51 .471
40~49 13 (50.0) 13 (50.0)
≥50 7 (70.0) 3 (30.0)
Educational level ≤High school 13 (46.4) 15 (53.6) 0.37 .204
≥University 12 (63.2) 7 (36.8)
Marital status Single 4 (50.0) 4 (50.0) 0.34 .573
Married 21 (53.8) 18 (46.2)
Occupation No 6 (35.3) 11 (64.7) 0.08 .061
Yes 19 (63.3) 11 (36.7)
Cancer stage I 13 (65.0) 7 (35.0) 2.62 .270
II 10 (41.7) 14 (58.3)
III 2 (66.7) 1 (33.3)
Method of surgery Partial mastectomy 23 (51.1) 22 (48.9) - .278†
Total mastectomy 2 (100.0) 0 (0.0)
Chemotherapy No 9 (75.0) 3 (25.0) 3.08 .077
Yes 16 (45.7) 19 (54.3)
Hormonal therapy No 4 (57.1) 3 (42.9) - .574†
Yes 21 (52.5) 19 (47.5)
Target therapy No 23 (51.1) 22 (48.9) - .278†
Yes 2 (100.0) 0 (0.0)

Exp.=Experimental group; Cont.=Control group.

Fisher’s exact test.

Homogeneity Tests of Dependent Variables between Two Groups

Variable Exp. (n=25) Cont. (n=22) t or z p
M±SD M±SD
Distress 5.40±3.03 4.63±2.26 -0.99 .329
Supportive care needs
  Psychological needs 53.30±29.84 47.16±22.66 -0.78 .436†
  Health system and information needs 50.09±31.92 49.79±27.94 -0.14 .890†
  Physical and daily living needs 18.60±21.91 30.91±23.89 -1.96 .051†
  Patient care and supportive needs 27.00±17.91 31.36±28.54 -0.10 .923†
  Sexuality needs 14.67±17.39 15.01±24.52 -0.29 .773†
Quality of life 96.85±15.15 96.51±14.77 -0.24 .814
  Physical well-being Social/family well-being 23.60±3.25 21.96±4.72 -1.43 .159
  Social/family well-being 17.89±5.54 17.23±5.96 -0.44 .662
  Emotional well-being 14.52±5.84 17.24±3.35 -1.42 .155
  Functional well-being 17.44±4.32 15.84±4.09 -1.59 .120
  Breast cancer-specific subscale 23.36±4.51 24.28±4.07 0.01 .998

Exp.=Experimental group; Cont.=Control group; M=Mean; SD=standard deviation.

Mann-Whitney U test.

Comparison of Distress and Quality of Life between Two Groups

Variable Group Time Difference Difference Cohen’s d
T1 T2 T3 Source F (p) (T2-T1) (T3-T1) Exp.~Cont.
M±SD M±SD M±SD M±SD t (p) M±SD t (p) T2 T3 T3
Distress Exp. (n=25) 5.40±3.03 2.52±1.69 1.88±1.54 Group 0.95 (.336) -2.88±2.71 -2.94 (.005) -3.52±3.64 -1.32 (.195) 0.84 0.37
Time 28.06 (<.001)
Cont. (n=22) 4.63±2.26 4.13±2.23 2.27±1.66 Group×Time 4.56 (.017) -0.50±2.84 -2.36±2.30
Quality of life Exp. (n=25) 96.85±16.14 99.79±8.90 102.11±7.74 Group 9.86 (.003) 2.94±17.60 2.69 (.010) 5.26±15.70 2.28 (.027) 0.77 0.66
Time 2.30 (.125)
Cont. (n=22) 95.70±12.15 86.92±9.49 91.95±11.41 Group×Time 5.74 (.011) -8.79±11.10 -3.76±10.52
Physical well-being Exp. (n=25) 23.60±3.25 21.32±2.81 22.04±3.02 Group 5.00 (.030) -2.28±4.00 1.20 (.235) -1.56±2.10 -0.33 (.740) 0.35 0.10
Time 11.51 (<.001)
Cont. (n=22) 22.27±4.17 18.31±3.78 21.18±4.94 Group×Time 1.49 (.230) -3.95±5.49 -1.09±5.50
Social/family well-being Exp. (n=25) 17.89±5.54 18.27±2.37 18.55±2.47 Group 2.81 (.101) 0.38±5.95 0.56 (.582) 0.66±6.15 1.12 (.269) 0.16 0.32
Time 0.05 (.900)
Cont. (n=22) 17.20±5.00 16.73±3.89 16.12±4.56 Group×Time 0.82 (.408) -0.47±4.30 -1.08±4.13
Emotional well-being Exp. (n=25) 14.52±5.84 18.32±2.90 19.60±2.16 Group 0.15 (.702) 3.80±7.11 2.47 (.019) 5.08±6.56 3.13 (.003) 0.68 0.87
Time 7.67 (.003)
Cont. (n=22) 17.18±2.97 17.09±3.02 17.45±2.44 Group×Time 6.65 (.003) -0.09±3.16 0.27±3.73
Functional well-being Exp. (n=25) 17.44±4.32 18.00±3.71 18.28±3.48 Group 4.68 (.036) 0.56±6.21 0.26 (.800) 0.84±5.84 -0.11 (.910) 0.07 0.03
Time 1.05 (.340)
Cont. (n=22) 15.77±2.79 15.95±3.98 16.77±3.89 Group×Time 0.09 (.860) 0.18±3.30 1.00±3.27
Breast cancer-specific subscale Exp. (n=25) 23.36±4.51 23.24±4.32 23.28±4.39 Group 5.00 (.030) -0.12±5.13 3.02 (.004) -0.08±4.57 2.05 (.047) 0.87 0.59
Time 6.81 (.004)
Cont. (n=22) 23.36±3.30 19.05±4.46 20.55±4.50 Group×Time 6.09 (.006) -4.32±4.29 -2.82±4.58

Exp.=Experimental group; Cont.=Control group; T1=Before intervention; T2=Immediately after intervention; T3=6 months after the end of intervention; M=Mean; SD=standard deviation.

Comparison of Supportive Care Needs between Two Groups

Variables Group Time Difference Difference (T3-T1)
T1 T2 T3 χ2 (p) (T2-T1)
M±SD M±SD M±SD M±SD z† (p) M±SD z† (p)
Psychological needs Exp. (n=25) 53.30±29.84 38.50±20.67 32.20±20.02 15.90 (<.001) -14.80±33.20 -2.72 -21.10±27.76 -1.46
Cont. (n=22) 47.16±22.66 58.07±16.61 37.73±21.90 8.81 (.012) 10.91±29.12 (.007) -9.43±31.21 (.144)
Health system and information needs Exp. (n=25) 50.09±31.92 28.91±14.44 26.82±19.06 8.83 (.013) -21.18±35.27 -2.68 -23.27±31.67 -0.65
Cont. (n=22) 49.79±27.94 61.47±19.14 36.67±26.16 9.39 (.009) 11.67±37.92 (.007) -13.12±36.32 (.515)
Physical and daily living needs Exp. (n=25) 18.60±21.91 29.00±19.03 17.20±17.44 6.61 (.037) 10.40±27.00 -1.21 -1.40±26.91 -0.24
Cont. (n=22) 30.91±23.89 52.50±27.80 30.22±21.95 9.02 (.011) 21.59±34.38 (.227) -0.68±23.11 (.814)
Patient care and supportive needs Exp. (n=25) 27.00±17.91 21.60±19.24 15.20±13.27 5.58 (.058) -5.40±30.55 -1.95 -11.80±23.80 -1.93
Cont. (n=22) 31.36±28.54 43.41±26.33 30.91±26.89 6.79 (.034) 12.05±40.26 (.052) -0.45±36.48 (.054)
Sexuality needs Exp. (n=25) 14.67±17.39 19.33±23.78 15.00±19.39 0.27 (.873) 4.67±22.45 -3.28 0.33±24.71 -0.02
Cont. (n=22) 15.01±24.52 48.86±25.76 14.02±22.48 19.92 (<.001) 32.95±30.59 (.001) -1.89±28.86 (.982)

Exp.=Experimental group; Cont.=Control group; T1=Before intervention; T2=Immediately after intervention; T3=6 months after the end of intervention; M=Mean; SD=standard deviation.

Mann-Whitney U test.